“As COVID-19 forces separation from loved ones and increases anxiety for people with cancer and their caregivers, providing emotional support virtually is more important than ever. This study shows how effective video conferencing interventions can be in improving the emotional wellbeing of remote caregivers, who in turn provide critical support for patients,” said ASCO President Howard A. "Skip" Burris III, MD, FACP, FASCO.
A video conferencing intervention significantly reduced levels of anxiety and distress among “distance caregivers" who live more than an hour away from the patients with cancer they support, according to the results of a federally funded study.
About the Study
The randomised controlled trial was conducted at a large urban comprehensive cancer centre, though distance caregivers in the study lived in a variety of settings. Participants were randomised to receive one of three interventions.
Participants in arm 1 received 4 monthly video conference coaching sessions with a nurse practitioner or social worker, focused on providing information and support; were able to participate in patient-oncologist visits via video conference; and had access to a website with information specifically designed for distance caregivers.
Arm 2 participated in virtual patient-oncologist visits and had access to the same website.
Arm 3 had access to the website only.
A total of 441 patient-caregiver groups were enrolled.
The average age of distance caregivers was 47 years; 71% were female, and 63% of caregivers were children of the patient.
The average age of patients was 65 years; 60% were female, and 30% and 18% had gastrointestinal and haematologic cancers respectively.
Of patients with solid tumours, 59% had stage-IV disease.
The researchers assessed changes in levels of distress and anxiety before and after the interventions using a questionnaire completed before randomisation and at the end of the 4-month intervention.
Though providing online coaching sessions with advanced practice nurses or social workers may not be feasible for all cancer centres due to cost and resource limitations, the authors note that video conferencing distance caregivers into patient appointments and providing web resources designed specifically for distance caregivers will still yield some improvement in distress and anxiety levels.
Distance caregivers report higher levels of distress and anxiety than caregivers who live nearby, which can negatively affect their employment, quality of life, and overall physical health.
This distress and anxiety are often caused by uncertainty regarding the patient’s condition or a lack of first-hand information from clinical visits.
Approximately 20% of caregivers live more than 1 hour away from patients with cancer, and nearly a third of distance caregivers are the sole caregiver for their loved ones.
Despite the unique challenges facing distance caregivers, no interventions have been developed specifically for this group until now.
To address these challenges, researchers developed a three-part intervention to support distance caregivers, comprised of monthly video conference coaching sessions with a nurse practitioner or social worker, focused on providing information and support; videoconference participation in patient-oncologist visits; and access to a website with resources designed specifically for distance caregivers.
Of the distance caregivers who received the full intervention (those in arm 1), 19.2% experienced significantly reduced anxiety and 24.8% reported reduced distress. In Arm 2, 17.3% had improvements in anxiety scores and 19.8% had improvements in distress scores.
“Distance caregivers experience a tremendous amount of anxiety and distress – often greater than people with cancer themselves,” said Sara L. Douglas, PhD, RN, lead author of the study, the Gertrude Perkins Oliva Professor in Oncology Nursing and Assistant Dean for Research at the Case Western Reserve University School of Nursing.
“With COVID-19, the challenges that distance caregivers face are now the same challenges facing many local caregivers who can’t attend their loved ones’ appointments. Our video conferencing intervention shows that it’s possible to meaningfully reduce anxiety and distress for distance caregivers through fairly simple technology.”
These findings have particular relevance during the COVID-19 pandemic as social distancing practices have increased the number of caregivers providing remote support for their loved ones with cancer.
The study will be featured in the virtual scientific program of the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting.
The researchers plan to test this intervention in other caregiver populations (e.g. patients with Alzheimer's disease). They also plan to work with healthcare providers to offer video conference technology to cancer patients with a distance caregiver.